Abstract Spain has experienced a remarkable 1.3ºC temperature increase, higher than the average world temperature increase registered since pre-industrial period. This trend for a crop such as pistachio (P. vera L.) can lead to changes in the flowering of females and males). Being a crop in full expansion in Spain with more than 50,000 ha, of which 35,000 were planted in the last 5 years; potential pollination problems could have negative impacts on new pistachio fields. Therefore, it is very important to consider these climatic issues when choosing the cultivar. This work studies the phenological variations in the main cultivars taking into account climatic and phenological data of four years in two-time frames separated by 18 years. Phenological characteristics of pistachio were studied deeply, suggesting the best combinations of the most common cultivars. Variations in the flowering season were observed, especially in males where an early flowering has been noted and, more strongly, a shortening of the useful period for pollination. The average temperature increase registered in these 18 years (around +0.4 Cº) has provided the basis for this study, which could be a useful tool for farmers in the future since we could possibly witness a further increase in average temperatures in next years.

Resumen España ha sufrido un aumento de temperatura (+1,3ºC) superior a la media mundial desde la época pre-industrial. Para un cultivo leñoso como el pistachero (P. vera L.), el calentamiento global puede suponer cambios en la floración de hembras y machos. Siendo un cultivo en plena expansión en España con más de 50.000 ha, 35.000 implantadas en los últimos 5 años; problemas potenciales de polinización tendrían un impacto negativo en las nuevas plantaciones. Por lo tanto, es importante considerar estas variaciones climáticas al elegir el cultivar. Este estudio consiste en una observación de las variaciones fenológicas en los principales cultivares teniendo en consideración datos climáticos y fenológicos de 5 años en dos periodos separados 12años. Se ha profundizado en las características fenológicas del pistachero, pudiendo sugerir las mejores combinaciones de los cultivares comunes. Se han detectado variaciones en la época de floración, sobre todo en machos con un adelantamiento en la aparición de esta fase y, especialmente, un acortamiento del periodo útil para la polinización en las hembras. El aumento de temperatura media registrada en estos 18 años (alrededor de +0,4 Cº) ha motivado este estudio que podría ser una herramienta para el cultivo futuro, que incluye la posibilidad de un ulterior aumento de las temperaturas medias en los próximos años.

Abstract Background and objectives: In this systematic review, we carried out an assessment of perioperative costs of local or regional anesthesia versus general anesthesia in the ambulatory setting. Methods: A systematic literature search was conducted to find relevant data on costs and cost-effectiveness analyses of anesthesia regimens in outpatients, regardless of the medical procedure they underwent. The hypothesis was that local or regional anesthesia has a lower economic impact on hospital costs in the outpatient setting. The primary outcome was the average total cost of anesthesia calculated on perioperative costs (drugs, staff, resources used). Results: One-thousand-six-hundred-ninety-eight records were retrieved, and 28 articles including 27,581 patients were selected after reviewing the articles. Data on the average total costs of anesthesia and other secondary outcomes (anesthesia time, recovery time, time to home readiness, hospital stay time, complications) were retrieved. Taken together, these findings indicated that local or regional anesthesia is associated with lower average total hospital costs than general anesthesia when performed in the ambulatory setting. Reductions in operating room time and postanesthesia recovery time and a lower hospital stay time may account for this result. Conclusions: Despite the limitations of this systematic review, mainly the heterogeneity of the studies and the lack of cost-effectiveness analysis, the economic impact of the anesthesia regimes on healthcare costs appears to be relevant and should be further evaluated.

Abstract Background and objectives: Contribution margin per hour (CMH) has been proposed in healthcare systems to increase the profitability of operating suites. The aim of our study is to propose a simple and reproducible model to calculate CMH and to increase cost-effectiveness. Methods: For the ten most commonly performed surgical procedures at our Institution, we prospectively collected their diagnosis-related group (DRG) reimbursement, variable costs and mean procedural time. We quantified the portion of total staffed operating room time to be reallocated with a minimal risk of overrun. Moreover, we calculated the total CMH with a random reallocation on a first come-first served basis. Finally, prioritizing procedures with higher CMH, we ran a simulation by calculating the total CMH. Results: Over a two-months period, we identified 14.5 hours of unutilized operating room to reallocate. In the case of a random ‘‘first come -first serve’’ basis, the total earnings were 87,117 United States dollars (USD). Conversely, with a reallocation which prioritized procedures with a high CMH, it was possible to earn 140,444 USD (p < 0.001). Conclusion: Surgical activity may be one of the most profitable activities for hospitals, but a cost-effective management requires a comprehension of its cost profile. Reallocation of unused operating room time according to CMH may represent a simple, reproducible and reliable tool for elective cases on a waiting list. In our experience, it helped improving the operating suite cost-effectiveness.

Objectives: Although an association has been found recently between obsessive-compulsive disorder and an increased risk of suicide, the prevalence of both suicidal ideation and attempts vary considerably and are generally assessed categorically. Our aims were to evaluate the prevalence of suicidal ideation and behaviors using a dimensional approach. Methods: The sample included 129 patients with obsessive-compulsive disorder. Suicidality was assessed by administering the Columbia-Suicide Severity Rating Scale. Logistic and linear regressions were used to examine predictors of suicidal ideation, severe suicidal ideation, and suicidal behavior. Results: The lifetime prevalence of suicidal ideation and behaviors were 64.3% and 16.3%, respectively. Lifetime suicidal ideation was associated with the number of stressful life events, duration of illness, Hamilton Rating Scale for Depression scores, and family history of mood disorders. A family history of obsessive-compulsive disorder was associated with a lower probability of lifetime suicidal ideation. Severe suicidal ideation was related to greater severity of the most stressful life event, Hamilton Rating Scale for Depression scores, and longer duration of untreated illness. The probability of lifetime suicidal behavior was related to Hamilton Rating Scale for Anxiety scores, symmetry obsessions, and washing and checking compulsions. The probability of lifetime non-suicidal self-injurious behaviors was related to Hamilton Rating Scale for Anxiety scores. Conclusions: Recognizing predictors of suicidal ideation/behavior is crucial to identifying patients at greater risk.

RESUMO Objetivo: A amostragem citológica por meio de EBUS-TBNA é realizada rotineiramente para diagnóstico anatomopatológico, estadiamento mediastinal e teste molecular em pacientes com câncer de pulmão. As amostras obtidas por meio de EBUS-TBNA não são formalmente aceitas para testar a expressão da proteína programmed death-ligand 1 (PD-L1, ligante de morte celular programada 1). O objetivo do estudo foi comparar a viabilidade, reprodutibilidade e precisão da avaliação da expressão de PD-L1 em espécimes citológicos e amostras histológicas. Métodos: Foram coletadas prospectivamente amostras histológicas (obtidas por meio de biópsia transbrônquica com pinça) e citológicas (obtidas por meio de EBUS-TBNA) de lesões neoplásicas peribrônquicas durante um procedimento endoscópico na mesma lesão-alvo para o diagnóstico anatomopatológico e avaliação molecular de câncer pulmonar de células não pequenas (CPCNP) em estágio IV. Resultados: Quinze pacientes foram submetidos ao procedimento. Amostras citológicas adequadas (pelo menos 100 células neoplásicas) foram obtidas em 12 casos (92,3%). A expressão de PD-L1 nas amostras histológicas e citológicas foi semelhante (taxa de concordância = 92%). A sensibilidade e precisão diagnóstica das amostras citológicas obtidas por meio de EBUS-TBNA foram de 88,9% e 100%, respectivamente. Conclusões: A avaliação da expressão de PD-L1 em espécimes citológicos obtidos por meio de EBUS-TBNA é viável e apresenta boa reprodutibilidade quando comparada com amostras histológicas rotineiras. Amostras citológicas obtidas por meio de EBUS-TBNA podem ser usadas para avaliar a expressão de PD-L1 como uma abordagem minimamente invasiva em pacientes com CPCNP em estágio IV.

ABSTRACT Objective: EBUS-TBNA cytological sampling is routinely performed for pathological diagnosis, mediastinal staging, and molecular testing in lung cancer patients. EBUS-TBNA samples are not formally accepted for testing programmed death-ligand 1 (PD-L1) expression. The objective of the study was to compare the feasibility, reproducibility, and accuracy of PD-L1 expression assessment in cytological specimens and histological samples. Methods: We prospectively collected histological (transbronchial forceps biopsy) and cytological (EBUS-TBNA) samples from peribronchial neoplastic lesions during an endoscopic procedure at the same target lesion for the pathological diagnosis and molecular assessment of stage IV non-small cell lung cancer (NSCLC). Results: Fifteen patients underwent the procedure. Adequate cytological samples (at least 100 neoplastic cells) were obtained in 12 cases (92.3%). Assessment of PD-L1 expression was similar between histological and cytological samples (agreement rate = 92%). Sensitivity and diagnostic accuracy of EBUS-TBNA cytological specimens were 88.9% and 100%, respectively. Conclusions: The evaluation of PD-L1 expression in EBUS-TBNA cytological specimens is feasible and presents good reproducibility when compared with routine histological samples. EBUS-TBNA cytological samples could be used for the assessment of PD-L1 expression in patients with NSCLC as a minimally invasive approach in stage IV NSCLC cancer patients.

Objective: Extended pelvic lymph nodes dissection (EPLND) allows the removal of a higher number of lymph nodes than limited PLND. The aims of this study were to describe our robot-assisted EPLND (RAEPLND) technique with related complications, and to report the number of lymph nodes removed and the rate of lymph nodal metastasis. Materials and Methods: 153 patients underwent RAEPLND prior to robot-assisted radical prostatectomy (RARP). Indications were defined according to Briganti nomogram, to predict risk of lymph-nodal metastasis. Lymphatic packages covering the distal tract of the common iliac artery, the medial portion of the external iliac artery, the external iliac vein and the internal iliac vessels, together with the obturator and the presacral lymphatic packages were removed on both sides. Results: Median preoperative PSA was 7.5 ng/mL (IQR 5.5–11.5). Median operative time was 150 min (135–170). Median RAEPLND alone operative time was 38 min (32.75–41.25); for right and left side, 18 (15–29) and 20 min (15.75–30) (p=0.567). Median number of lymph nodes retrieved per patient was 25 (19.25–30); 13 (11–16) and 11 (8–15) for right and left side. In 19 patients (12.41%) metastasis was found at the level of pelvic lymph nodes. Median number of positive lymph nodes was 1 (1–4.6) per patient. Complications occurred in 11 patients (7.3%). Conclusions: the number of lymph nodes removed was comparable to published data about open series, allowing the increase of detection rate of lymph nodal metastasis for minimally invasive approach without compromising complications' rate if performing the procedure following reported technique.

Este trabalho apresenta um estudo realizado para analisar o estado atual da oferta e da demanda por ensino superior na área de logística de transporte ferroviário. Mais especificamente, o estudo apresentado consiste de duas pesquisas, como se segue. A primeira pesquisa, Pesquisa Abastecimento, explora de transporte existente e logística relacionados com cursos e programas educacionais oferecidos em instituições de ensino superior. A segunda pesquisa, de levantamento de demanda, que analisa as demandas para a educação superior e de logística ferroviária, tem como objetivo compreender as necessidades atuais para o ensino superior no setor. Este trabalho mostra que existe um amplo espectro de transporte ferroviário de mercadorias, logística e cursos relacionados e programas, mas que, no entanto, há uma forte necessidade de uma formação mais específica e de educação que possibilite a formação de competências em gestão de operações, necessárias para melhorar o desempenho da empresa, a eficiência e a qualidade do serviço prestado.

This paper includes a study conducted to analyse the current state of supply and demand for higher education in rail logistics. More specifically the study presented consists of two surveys, as follows. The first survey, Supply Survey, explores existing transport and logistics-related courses and educational programmes offered in higher education institutions. The second survey, Demand Survey, examines demands for rail logistics higher education and aims to understand the current needs for higher education in the sector. This paper shows that a spectrum of rail, freight transport and logistics related courses and programmes exist, however there is a strong need for a more specific training and education offering operations management skills needed to improve the company performance, efficiency and quality of service provided.